Immunizations
Required Vaccinations
Yellow Fever
This viral infection is transmitted by the day-time biting Aëdes aegypti mosquito typically found in urban, suburban, and rural areas.
A Yellow Fever vaccination certificate is required only for travellers coming from, or in transit through, infected countries. The vaccination requirement is imposed by this country for protection against the introduction of Yellow Fever since the vector Aëdes aegypti is present in its territory.
The following countries are considered infected:
AFRICA - Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Republic of the Congo, Democratic Republic of the Congo, Côte d'Ivoire, Equatorial Guinea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Rwanda, São Tomé and Príncipe, Senegal, Sierra Leone, Somalia, Sudan, Tanzania, Togo, Uganda.
AMERICAS - Argentina, Bolivia, Brazil, Colombia, Ecuador, Guyana, French Guiana, Panama, Paraguay, Peru, Suriname, Trinidad and Tobago, Venezuela.
Note: A vaccination certificate is required for children over one year of age.
Recommended Vaccinations
Routine Immunizations
Your trip is a good occasion for a reminder to keep your routine immunizations updated; more than 80% of adults in developed countries have not maintained their immunization status. The following vaccinations are recommended for your protection and to prevent the spread of infectious diseases.
Tetanus-Diphtheria, Poliomyelitis, Measles, Mumps, Rubella should be reviewed and updated if necessary.
Seasonal influenza vaccine is recommended for children, persons over the age of 50, and those of any age suffering from chronic heart disease, emphysema, asthma, renal disorders, immuno-suppressive disorders, and organ transplant recipients. Note: Flu seasonal patterns are opposite in the southern and northern hemispheres. If the flu vaccine is not available at the time of departure, contact your doctor or travel health clinic regarding influenza anti-viral protection.
Pneumococcal vaccine is recommended for persons over the age of 65 and persons of any age suffering from cardiovascular disease, diabetes, renal disorders, liver diseases, sickle cell disease, asplenia, or immuno-suppressive disorders.
Hepatitis A
The Hepatitis A virus is primarily transmitted through contaminated water and food or by the fecal-oral route, and may cause severe liver damage. Prevention includes good personal hygiene, ensuring safe water supply, eating well cooked foods, and peeling your own fruits.
Vaccination is recommended for all travellers over one year of age. The vaccine is often combined with Hepatitis B and affords excellent long-term protection for both viral diseases.
Typhoid Fever
This intestinal infection, caused by Salmonella typhi bacteria, is transmitted from person to person primarily through ingestion of contaminated food and water in areas with poor sanitary and hygienic conditions. Prevention includes good personal hygiene such as washing your hands frequently, ensuring safe water supply, eating well cooked foods, and peeling your own fruits. Vaccination is also recommended for travellers' protection.
Selective Vaccinations
Hepatitis B
The Hepatitis B virus is transmitted through infected blood products, sexual intercourse, or infected items such as needles or razor blades, and may cause severe liver damage.
Vaccination is recommended for persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), or for those working in close contact with the local population (teachers, aid workers, missionaries), or persons foreseeing sexual relations with locals. This vaccine is often combined with the Hepatitis A vaccine and affords excellent long-term protection for both viral diseases.
Rabies
This viral infection is transmitted through the saliva of infected animal bites which affects the brain and the spinal cord, and may be fatal.
A series of three (3) pre-exposure rabies vaccination shots is advised for persons planning an extended stay or on working assignments in remote and rural areas, particularly in Africa, Asia, Central and South America. The pre-exposure series simplifies medical care if the person has been bitten by a rabid animal. Although this provides adequate initial protection, a person potentially exposed to rabies will require two (2) additional post-exposure innoculations.
Persons who have not received the pre-exposure shots need five (5) injections in addition to rabies immune globulin (RIG). RIG is in short supply around the world and may not be available in remote areas. If a traveller has had the three pre-exposure shots, they will only need additional two shots; they do not need RIG.
Children are especially vulnerable since they may not report scratches or bites. They should be cautioned not to pet dogs, cats, monkeys, or other mammals. Any animal bite or scratch must be washed repeatedly with copious amounts of soap and water. Seek medical attention immediately.
The recommendations for vaccinations outlined above are intended as guidelines only. Your immunization needs depend on your health status, previous immunizations received, and your travel itinerary. Seek further advice from your doctor or travel health clinic.
Disease Risks
MALARIA
Infection is spread by the night-time - dusk to dawn - biting female Anopheles mosquito.
Malaria risk is present in the country; areas of risk are specified:
Rural and urban areas in the northeastern parts Botswana including Boteti, Shobe, Ngamiland, Okavango, Tutume, as well as the areas along the border with Zimbabwe and the Limpopo River valley bordering South Africa's Northern (Limpopo) Province.
Note: The city of Gabarone is risk free.
High risk months for Malaria are: November - June
Malaria transmission vector(s): A. gambiae
Incidence of Plasmodium falciparum Malaria: 90%
Of the four species of human malaria parasites, Plasmodium falciparum is the most dangerous. The remaining percentage represents vivax group infections (benign forms of malaria caused by Plasmodium vivax, Plasmodium ovale and Plasmodium malariae.)
Areas with drug resistant Malaria: P. falciparum malaria is resistant to chloroquine. Resistance is present in all malarious areas.
Suppressive Medication Guide:
For details on anti-malarial drug side-effects, dosages for children and pregnant women, medications used around the world, and comprehensive protection measures, see: How to Protect Yourself Against Malaria (pdf)
SCHISTOSOMIASIS
Infection is transmitted by snails living in fresh water such as lakes, rivers, streams and ponds in the Caribbean, South America, Africa, and Southeast Asia.
Schistosomiasis risk is present in the country, areas of risk are specified:
Infection with S. haematobium is present along the Limpopo River valley and its tributaries. Localized infections with S. haematobium exist in Mabule (on the Molopo River, Southern district), Francistown (North-East district), Xhumo and Nata (Letlhakane district), Pandamatenga, Kasane, and Kavimba (Chobe district), as well as Maun, and Tsao (Ngamiland).
Infection with S. mansoni is endemic in the northern districts of Okavango and Chobe, particularly along the Okavango River and marshlands, and in the villages along the Chobe River.
Note: The districts of Kgalagadi, Ghanzi and Central--Serowe (Kalahari Desert) are risk free.
There is a risk of Schistosomiasis caused by: Schistosoma haematobium, Schistosoma mansoni
The main intermediate host snail is: Bulinus globosus, Bulinus africanus, Biomphalaria pfeifferi.
Prevention Guidelines:
OTHER DISEASES OF INTEREST TO TRAVELLERS
Hepatitis C
The Hepatitis C virus is transmitted from person to person through unscreeened blood transfusions, blood products, contaminated needles and instruments used for tattooing and body piercing. Travellers are at risk of infection in countries where the blood supply is not adequately screened and a transfusion is required after an accident. Avoid body piercing and tattooing. The virus may also be transmitted sexually.
Hepatitis C is endemic in Botswana.
Hepatitis E
Hepatitis E is caused by infection with the hepatitis E virus. It is transmitted mainly through contaminated water or food by the fecal-oral route. It is common in countries with low standards of sanitation. Prevention includes good personal hygiene, ensuring water supply is safe, and following food safety measures (eating food well-cooked and hot, peeling your own fruits, etc...).
High risk of Hepatitis E exists in Botswana.
Sexually Transmitted Infections
Avoid unprotected sexual contact. If you are going to have sex with a stranger, use latex or polyurethane condoms consistently and correctly. Bring your own condoms from home.
Some countries have entry restrictions for travellers with HIV / AIDS. See The Global Database on HIV Related Travel Restrictions for details on this country.
Hepatitis B and C may be transmitted sexually.
Traveller's Diarrhea
Diarrhea is the most common cause of illness during travel. The source of illness is the ingestion of contaminated food or water, person-to-person transmission, or recreational exposure to water bodies. The infective agents can be bacteria, viruses, protozoa or toxins found in food. Good personal hygiene practices (including frequent and thorough hand washing), proper food handling, and water purification are the most effective methods to prevent infection.
Consult your doctor for the best treatment options tailored to your needs, including taking prescription medication on your trip in case you suffer from diarrhea. Travellers with chronic conditions are more susceptible to infections and should consider taking preventive medication.
See our Guide to Healthy Travel for prevention and treatment tips.
Tuberculosis
Tuberculosis is transmitted from person to person through inhalation of airborne infectious respiratory droplets. Travellers who have only casual contact with infected persons are at low risk.
However, travellers visiting friends and relatives (especially young children) in developing countries, persons on working assignments in the health care field (dentists, physicians, nurses, laboratory technicians), long-term travellers and those who have close and prolonged contact with the local population (teachers, missionaries, Peace Corps volunteers) are at risk. Travellers at risk should have a pre-departure TB skin test and be re-tested after leaving the country.
Tuberculosis is endemic in Botswana and a significant health problem.
DISEASES PRESENT - LOW RISK TO TRAVELLERS
Plague
Plague is mostly a zoonotic bacterial infection of rodents caused by Yersinia pestis and is transmitted to humans and animals through bites by infected fleas. Person to person infection can occur through respiratory secretions. Rapid diagnosis and treatment with antibiotics is imperative since untreated infection has a high mortality rate. The Plague vaccine is no longer commercially available.
Most travellers are not at risk from the Plague, however, persons who may be occupationally exposed to wild rodents (anthropologists, archeologists, geologists, spelunkers) or hunters, hikers, and campers in endemic areas must avoid contact with rodents.
Risk is present in the northern part of the country. An outbreak was reported in the district of Boteti.
Trypanosomiasis, African Sleeping Sickness
There are two types of African trypanosomiasis (also called sleeping sickness); each named for the region of Africa in which it was found historically. Individuals can become infected with West African trypanosomiasis if they receive a bite from an infected tsetse fly, which is only found in Africa.
West African trypanosomiasis, also called Gambian sleeping sickness, is caused by a a parasite called Trypanosoma brucei gambiense carried by the tsetse fly. The tsetse flies that transmit West African trypanosomiasis are found only in rural areas. Travellers to urban areas are not at risk. The flies bite during daylight hours. They inhabit forests and areas of thick vegetation along rivers and waterholes. Travellers are not at great risk for contracting the disease unless they are travelling and spending long periods of time in rural areas of central Africa where the disease is present. Travellers at risk should take precautions against (tsetse fly) bites.
East African trypanosomiasis is transmitted by the bite of the tsetse fly infected with the parasite Trypanosoma brucei rhodesiense. The number of tsetse flies that are infected with this parasite is low. The tsetse fly is found only in rural Africa. Tsetse flies are found in woodland and savannah areas and they bite during daylight hours. Travellers to urban areas are not at risk. Persons most likely to be exposed to the infection are tourists, hunters and others working or visiting game parks. Travellers at risk should take precautions against insect (tsetse fly) bites. Insect bite prevention measures include wearing appropriate clothing (long sleeves, long pants, etc...), and applying permethrin spray or solution to clothing and gear. Insect repellents containing-DEET are not effective against tsetse flies.
Tungiasis
Tungiasis is a skin infestation of the Tunga penetrans flea found in tropical parts of Africa. Tungiasis affects persons walking barefoot or lying in infested sand or soil.
Food and Water Safety
In large urban areas, drinking water is chlorinated and has no ill effect on the local population. However, some strains of E. coli (naturally occurring bacteria found in your gastro-intestinal system) may be present in very small concentrations in the local water supply. Some local strains are different than those that you may be used to, and may cause diarrhea in travellers since immunity is not developed as a result of short-term exposure. Using bottled water for the first few weeks will help you adjust and decrease the chance of traveller's diarrhea.
In rural areas of Botswana, all local water should be considered contaminated. All water used for drinking, brushing teeth, and making ice cubes should be boiled (bring water to a rolling boil). Hot tea is advised as a beverage.
Milk is unpasteurized and should be boiled. Powdered and evaporated milk are available and safe. Butter should not be used as a table food. Cream, ice cream, and whipped cream should not be consumed. Cheese, unless cured, is best avoided. Yoghurt is safe only if it is known to be made from pasteurized milk.
All meat, poultry, and fish must be well cooked and served while hot. Pork is best avoided; vegetables should be well cooked and served hot. Salads are best avoided. Fruits with intact skins should be peeled by you just prior to consumption. Avoid raw and undercooked eggs, and dishes prepared with raw eggs (steak tartar, mayonnaise, and dressings). Avoid cold buffets, uncured cheeses, custards, and any frozen desserts.
First rate hotels and restaurants serve purified drinking water and reliable food. However, the hazard is left to your judgement.
Gastro-intestinal infections are the most common illnesses affecting travellers and can occur in any country you are visiting. Proper food handling, drinking purified water, and maintaining good personal hygiene are key to prevention. Below is a summary of the agents causing gastro-intestinal illnesses.
Bacterial Contamination
It is estimated that about 85% of traveller’s diarrhea is caused by bacteria of which the following are the most important agents:
Enterotoxigenic Escherichia coli (ETEC) and Enteroaggregative Escherichia coli (EAEC) account for most cases of traveller’s diarrhea associated with contaminated food and water world wide. They are the cause of large outbreaks in developed countries when food and water sanitation have not been properly maintained. Symptoms include watery stools, abdominal cramps, and possible vomiting lasting three to seven days.
Campylobacter jejuni is more prevalent in developing countries and is associated with contaminated water, undercooked food, and unpasteurized milk. Symptoms include diarrhea, abdominal cramps, and fever lasting from two to ten days.
Salmonella enteritidis is associated with contaminated eggs, poultry, milk, fruits, and uncooked vegetables. Symptoms include diarrhea, vomiting, abdominal cramps, and fever lasting from four to seven days. Infected persons can become asymptomatic carriers and shed the bacteria for years, becoming the source of infection for others through poor hygiene practices.
Shigellosis is a human infection caused by one of four species and transmitted by fecal-oral route due to unsanitary conditions, contaminated food and water, and overcrowded living conditions. Symptoms include diarrhea, abdominal cramps, fever, and may cause bloody diarrhea and mucous lasting four to seven days.
Vibrio cholera is associated with contaminated water, raw and undercooked seafood. Cholera infection in travellers is rare; symptoms include watery diarrhea and vomiting lasting three to seven days, but can lead to severe dehydration and death in undernourished persons. Vibrio parahaemolyticus is also related to the consumption of raw and undercooked seafood. Vibrio vulnificus is associated with contaminated shellfish and raw oysters in particular, and has caused septicemia in persons with liver disorders.
Viral Contamination
Gastro-intestinal infections caused by viruses account for about 5%. The main agents are Norovirus, associated with outbreaks at large gatherings and on cruise ships, and Rotavirus, which is more prevalent in developing countries. Symptoms include vomiting, diarrhea, fever, and myalgia lasting 12 to 60 hours.
Protozoal Contamination
Gastro-intestinal infections with protozoa account for about 10% of traveller’s diarrhea, but may cause prolonged illnesses (lasting weeks) and cause serious complications if not diagnosed in a timely manner.
Giardia lamblia (Giardiasis) and Entamoeba hystolytica (Amebiasis) are the most important agents in this category and both infections are acquired through contaminated food and water, as well as person to person transmission due to poor hygiene practices. Cryptosporidium and Cyclospora cayetanensis are implicated with contaminated food, water, and fresh produce (berries).
Toxins Causing Food Poisoning
Clostridium perfringens is the most important agent causing food poisoning in developed countries. The spores of the bacterium germinate on cooked food that is cooled and stored at room temperature over a prolonged period of time. After ingestion, the spores produce an enterotoxin in the small intestine causing abdominal pain, diarrhea, and vomiting. Foods implicated are meats and poultry.
Staphylococcus aureus enterotoxins are spread by unsanitary practices of infected persons. The foods implicated are custards, creamy desserts, meats, and salads.
Clostridium botulinum bacteria produce a very potent toxin. It is associated with improperly canned food, lightly preserved vegetables, salted fish, and meats. Symptoms include nausea, vomiting, and neurological symptoms such as blurred and double vision, paralysis of respiratory and motor muscles that may progress rapidly.
Seafood Poisoning
Fish and shellfish can be contaminated with the toxins produced by marine micro-organisms called dinoflagellates found in all oceans, especially in coral reef areas. Larger fish have usually more toxins accumulated in the skin, musculature, and organs, as these toxins are passed up through the food chain. The toxins are not destroyed through cooking, smoking, or freezing, they are odorless and tasteless, and do not alter the appearance of the fish.
Ciguatera Fish poisoning is the most common illness in this category. The most affected fish are amberjack, barracuda, grouper, kahala, parrotfish, sea bass, red snapper, surgeon fish, ulua. Symptoms usually appear within a few hours but can be delayed for a day or more and include nausea, vomiting diarrhea, muscle pain, itchiness, dizziness and temperature reversal (hot feels cold and cold feels hot). Symptoms can last for months. Persons who had a previous episode of ciguatera fish poisoning should avoid a second exposure as symptoms will be more severe. Prevention: Avoid large fish (more than 2.5 to 3 kilos [6 lbs]) or fillet of large fish, avoid head, roe, intestines and liver where the toxin is more concentrated.
Scombroid poisoning is the result of improper handling and refrigeration of fish containing high levels of natural occurring histidine (amino acid in protein). Contamination with bacteria will convert histidine to histamine-causing symptoms similar to allergic reactions, which occur very rapidly and include headache, abdominal cramps, diarrhea, itching, flushed face, and paralysis may occur. Scombroid poisoning occurs worldwide and affects fish from the Scombridae family: yellow tuna, mackerel, skipjack, and bonito. It can also affect other species such as herring, bluefish, sardine, anchovy, amberjack, and mahi-mahi. Prevention: Proper handling and immediate refrigeration of catch.
Shellfish poisoning is associated with the algal blooms (red tides) occurring in temperate and tropical areas. Shellfish – oysters, clams, cockles, mussels, crabs, lobsters – filter or ingest toxins produced by dinoflagellates micro-organisms. Each different toxin produces characteristic symptoms:
- Symptoms of diarrheic shellfish poisoning occur about 30 minutes to hours after ingestion and include nausea, vomiting, and diarrhea. Recovery occurs within two to three days.
- Symptoms of neurotoxic shellfish poisoning appear rapidly after ingestion and include tingling of mouth, arms and legs, stomach upset, and severe muscle pain. Recovery occurs within two to three days.
- Symptoms of paralytic shellfish poisoning appear rapidly after ingestion and include nausea, numbness of face arms and legs, headache, loss of coordination and dizziness, in severe cases respiratory failure and paralysis may lead to death.
- Symptoms of amnesic shellfish poisoning occur within 24 hours of ingestion and include vomiting, diarrhea, and disorientation. Permanent short-term memory loss has been observed, and in severe cases seizures, paralysis, and death may occur. Persons with kidney disease are especially vulnerable.
Puffer Fish poisoning (Fugu) is caused by a tetrodotoxin accumulating mainly in the liver, intestines and ovaries of puffer fish, ocean sunfish, globe fish, and porcupine fish. Symptoms appear between six and 20 hours and include profuse sweating, salivation, headache, hypothermia, and neurological symptoms of paralysis and respiratory failure. The mortality rate is very high.
